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Why Canadian medicare badly lags most countries: Cohn

Health Minister Eric Hoskins will make a pitch to his federal and provincial colleagues at a Thursday meeting in Vancouver to restore universal drug coverage to the national agenda. Canadians deserve the efficiencies and equities of a single payer system, the economies of scale from bulk purchasing, and the real time effectiveness of a co-ordinated “drug card” system that can access prescription histories, Martin Regg Cohn writes. (Chris Young / THE CANADIAN PRESS)

It is a miracle of modern medicine that Canadians remain so boastfully proud of medicare. Even though our universal health care system doesn’t pay for the modern medicines we need to stay healthy.

A half-century after Canada gave birth to medicare nationwide, pharmacare remains its forgotten orphan child. And a decade or so after our politicians vowed to make progress on pharmaceutical affordability (in 2004 and again in 2006), their 10-year deadline is dead in the water.

Now, Ontario wants to bring pharmacare back to life. Health Minister Eric Hoskins will make a pitch to his federal and provincial colleagues at a Thursday meeting in Vancouver to restore universal drug coverage to the national agenda.

It wasn’t supposed to be such a longshot. A year ago, when Hoskins convened several of his counterparts for an ad hoc roundtable discussion in Toronto, there was reason to believe 2015 would be a good year — it being an election year — to get the debate going again.

In fact, pharmacare fell further off the agenda. In the past, pharmacare had been an election perennial — promised in policy platforms released by the Liberals and Tories — but it didn’t even make the cut in the campaign of 2015.

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Our politicians talked about the right to assisted dying and debated access to marijuana (medical or otherwise). But they avoided any mention of the inalienable right to life-saving drugs for every Canadian, rich or poor, employed or jobless, pensioner or precarious worker.

Now that Justin Trudeau’s Liberals have taken over in Ottawa, will they show any more inclination to grapple with our medicare gap? Hoskins (a physician) will make the case yet again.

He is talking softly for fear of scaring off some of his still-skittish fellow health ministers with an Ontario (and doctor) knows best posture. Behind closed doors, Hoskins will stress three key points:

Linkage between future pharmacare and existing medicare cards. Any public plan should tie in to electronic health records that contain a patient’s past prescriptions. Avoiding drug interactions or abuse could pay significant health dividends.

Equity is key to removing financial barriers precluding patients from following doctor’s orders. Studies show that even modest co-payments can deter patients from filling their prescriptions, increasing the risk of recurring medical problems.

A national formulary, creating a common list of drugs that qualify for government subsidy (without political interference). Bulk buying would allow provinces to profit from their combined purchasing power.

At last year’s roundtable, ministers debated whether pharmacare should be universal and comprehensive, or still require patients to pay deductibles. The politicians also discussed fears that private insurers would kick up a fuss about being displaced.

One participant noted that if we had grappled with prescription drugs the way advanced West European countries have, we would be saving billions of dollars a year by now. Canada is second only to the U.S. in per capita spending on prescription drugs, well ahead of European countries.

In fact, Canada keeps paying the price for a wasteful, inefficient, inequitable, fragmented system that leaves every patient to fend for himself or herself — unless he or she has a company drug benefit plan, gets welfare, or qualifies for seniors’ subsidies. If you’re working poor, or merely working precariously (as many young people are today, jumping from job to job or flitting from contract to contract, never qualifying for benefits coverage) ... tough luck.

As precarious employment becomes the norm, expect more people to fall through the cracks. And count on those with drug benefits to stick with their current jobs, as they do in the U.S., reducing the employment mobility that is part of any healthy economy.

A half-century ago, politicians compromised on the creation of medicare by settling for a half-measure — delaying the drug battle for another day. Today, modern medicines are an even more critical component of lifesaving medical therapies. And the present-day economics of pharmacare make it that much more compelling.

Together, the moral and fiscal case has never been stronger: Canadians deserve the efficiencies and equities of a single payer system (compared to the fragmented and capricious U.S. free-for-all); the economies of scale from bulk purchasing; and the real time effectiveness of a co-ordinated “drug card” system that can access prescription histories.

Despite our self-image of Canada as an international poster child for medicare, our country remains an outlier among advanced industrialized nations — and a costly one at that. How many more decades until we fulfil the original promise of truly universal coverage?

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